Monitoring Access to Care in Medicaid

Chapter 4 looks at how states are monitoring access in Medicaid programs. As Medicaid enrollment and spending grow, federal and state governments alike want to ensure that it is effective—that is, not only that they are paying appropriately for care but also that beneficiaries have sufficient access to necessary care.

The chapter begins by defining access, referencing the framework MACPAC developed in 2011 for examining access to care for enrollees in Medicaid and CHIP. It then reviews what is known about access to care in Medicaid. MACPAC and others have found that Medicaid beneficiaries have much better access to care and higher health care utilization than individuals without insurance, particularly when controlling for socioeconomic characteristics and health status. Medicaid beneficiaries also fare as well, or better, on some access measures compared to individuals with private insurance, although they often experience more difficulty obtaining health care.

Chapter 4 also describes measures and data that can be used to monitor access for different populations and geographic areas and presents findings from MACPAC’s preliminary review of state plans. The Commission found that current monitoring approaches rely primarily on consumer complaint hotlines and advisory committee meetings. In addition, a survey of state practices found that monitoring efforts focused on primary and specialty care, behavioral health, and dental health, and that there was little variation in the number of states collecting data for particular populations. The chapter concludes with a discussion of key challenges to monitoring and evaluating access.

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About MACPAC

MACPAC serves as an independent source of information on Medicaid and CHIP issues that include payment, eligibility, enrollment, coverage, access to and quality of care, and the programs' interaction with Medicare and the health system generally. MACPAC’s authorizing statute requires it to submit two reports to Congress annually. The Commission holds public meetings and consults with state officials, congressional and executive branch staff, beneficiaries, health care providers, researchers, and policy experts to carry out its work.